Neurogenic Bowel Dysfunction in Children and Adolescents

Abstract

Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.

Overview On Neurogenic Bowel Dysfunction in Pediatrics

“…In almost all cases of neurogenic bowel dysfunction, it is the extrinsic nervous supply that is affected while the intrinsic enteric nervous supply remains intact. Patients with spinal cord lesions, either congenital or acquired, have an anatomically intact rectal ampulla, anal canal, and sphincter but experience constipation and/or incontinence due to damage of their enteric nervous system, reduced sensation, and limited mobility 24 . Pediatric NBD is typically brought on by congenital issues like spina bifida (SB).…”

“…Fiber Changing diet to contain higher fiber content is generally suggested as a first step in a bowel management program 63 . Generally, high fiber diet is recommended to prevent constipation 64 .…”

“…Be aware that insoluble fiber causes flatulence and bloating. A well-balanced diet should be encouraging, which contains fruits, vegetables, and enough of water, and constipating foods such as cheese and white rice should be limited 63 . Use caution while consuming substances that cause stools to become loose, such ijlpr2022;doi10.22376/ijpbs/lpr.2022.12.6.SP24.L37-49…”

“…Even though the lack of a strong evidence bases for these conservative interventions, they have been found to be beneficial in patients with NBD. Frequent activity can assist reduce constipation by promoting the bowel's peristaltic motility 63 .…”

Transanal Irrigation in Children: Treatment Success, Quality of Life, Adherence, Patient Experience, and Independence

“…In approximately 95% of children, no organic cause is found, and these children are diagnosed with functional constipation (FC) according to the Rome IV criteria ( 3 , 4 ). Organic causes of constipation include Hirschsprung disease or neurogenic/neuropathic bowel dysfunction (NBD) ( 5 ). Initial management consists of demystification, education, toilet training, and laxative treatment ( 6 , 7 ).…”